Family Webicine

By Rod Moser, PA, PhD

Perhaps the most medically underserved segment of our population is teenagers. Older teenagers are uncomfortable in a standard pediatric practice. This is where a seventeen-year-old linebacker must sit on dinosaur-themed examination paper and stare at pictures of Winnie the Pooh while waiting for his sports clearance. Equally as awkward would be the sexually active 16-year-old girl wanting confidential information about birth control, trying to talk the male pediatrician – the same one that did her baby shots and kindergarten exam.

Some teenagers end up going to a family practice; perhaps the same practice that his or her mother, father, and grandparents use. They worry constantly about confidentiality. As much as we tell them that their secrets are safe with us (the medical providers), there is always that underlying doubt that we may secretly tell their parents. Teenagers feel that all adults, including doctors, not only stick together, but are in some sort of conspiracy against them.

Teenagers deserve a medical practice where they feel at home, where they feel safe, and where their unique needs are not only recognized, but embraced.

My wife and I are both family practice trained PAs (Physician Assistants), so caring for people of all ages is second nature for us. Preferring to care for children in the twilight years of my practice, I joined a large pediatric group. My wife remained in family practice with a patient population that was heavy on the female side. Women often prefer women to care for them in a clinical setting.

The more I enmeshed my clinical career in pediatrics—having a blast caring for newborns, toddlers, and school-aged kids—the more adolescents migrated to my practice. Most were young men. I really like teenagers (not something everyone can honestly say), and they knew it. I asked them about their sports teams. I read about their touchdowns in the paper and remembered to high-five them on the next visit. I treated them like the young adults they were, not just big, hairy children. Then, an idea hit me. Why not form a Teen Clinic? I would recruit my wife from family practice and she would take care of the teen girls; I would handle the guys.

The concept of adolescent care was certainly not new or unique, but it was for our group. This was a million dollar idea that received a hundred dollar reception. We were given such a tight rein on the adolescent services we could provide that it was almost unworkable at first. The group committed to letting us order a (removable) vinyl sign that said “Teen Clinic,” and that was about it.

Leap forward five years. The pediatric group now tolerates the Teen Clinic as a viable concept, but has really not promoted it. My wife reluctantly agreed to join our group and has done a remarkable job with her faithful following of teen girls. Without making any moral judgments one way or the other, our group now has contraceptive services. The “Just Say No” policies of the past were not really working. Granted, many of the teen girls are on oral contraceptives just for their acne (so we were told), but what’s wrong with clear skin AND no unplanned pregnancies?

The parents love the Teen Clinic, but sadly, the Teen Clinic primarily served girls. If the teen boys wanted to see me, they had to go to a different floor of the medical facility, and they had to tolerate a bit of those Pooh Bear posters. That will soon change, because I decided to change my office to the Teen Clinic as soon as I return from my medical leave.

I am still going to see my babies and toddlers. I love them, too, but they are going to come to the Teen Clinic now. I am sure I will get a lot of questions from the five-year-olds if they see the STD or contraceptive posters, so I may try and set up a “neutral room”. I immediately envisioned Pooh Bear extolling the importance of using condoms, but alas, that would never happen. I may even develop some double-sided, laminated educational posters: one side for the little ones, and the no smoking, no drugs, no sex posters on the other side. It would be up to the medical assistant to flip ‘em before each visit. It could work but I can see mistakes happening.

“Mommy, what’s Chlamydia?”

“Ahhhhh…It’s a seafood soup! You wouldn’t like it.”

“Is that why that girl is crying?”

“Yes. She doesn’t like it, either. Her boyfriend gave it to her.”

“I don’t like boys.”

“That’s good. Let’s keep it that way for a long time. No soup for you!”